EMSC Medical Guidelines
Revised August 2014
Abdominal Pain (Non-Traumatic)
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Visualize and palpate the entire abdomen and retroperitoneal area
a. Note any tenderness, masses, and/or rigidity, noting which quadrant they appear in
b. If shock is suspected, place patient in shock position
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform SAMPLE exam
2. Perform PQRST exam
3. Inquire about vomiting/nausea (and blood in the vomit)
4. If patient is female, inquire about her recent menstrual cycles/potential pregnancies
5. Inquire about food and fluid intake/possibility of food poisoning
6. Inquire about regularity of urination and bowel movements (and blood in the urine or stool)
Dos and Don’ts
 Do anticipate vomiting
 Do reassess vital signs every 5 minutes
 Do write a run report
 Don’t give the patient anything by the mouth (food or liquids)
1
EMSC Medical Guidelines
Revised August 2014
Abdominal Pain (Traumatic)
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
5. Visualize and palpate the entire abdomen and retroperitoneal area
a. Note any tenderness, masses, and/or rigidity, noting which quadrant they appear in
b. Determine if there are any penetrating objects and stabilize accordingly if present
c. When patient presents with blunt trauma, take orthostatic blood pressure/pulse if patient presents
with no signs of shock
d. If evisceration is present, cover with large, bulky dressing soaked in saline and tape down on all
4 sides; keep dressing wet throughout transport
e. If gunshot or knife injury is present, check for exit wounds (if wound involves thoracic area, treat
it as a chest wound, see page 9)
f. If major blunt injury mechanism suspected, consider C-Spine
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
8. Perform rapid and detailed trauma assessments
a. Look for DCAPBTLS
Verbal Assessment
1. Inquire about injury mechanism
2. Perform SAMPLE exam
Dos and Don’ts
 Do anticipate vomiting
 Do reassess vital signs every 5 minutes
 Do write a run report
 Don’t give the patient anything by the mouth (food or liquids)
2
EMSC Medical Guidelines
Revised August 2014
Allergic Reactions and Anaphylaxis
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Check for associated SOB, obtain lung sounds, and note volume/anything abnormal
b. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
c. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
5. Check for and write down signs of systemic allergic reaction (rash, itching, hives, SOB,
generalized swelling, etc.)
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Expedite transport if patient’s status is acute
d. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
e. Provide ALS with the suspected allergen if possible
8. Assist patient with prescribed medications
a. Epi-pen, if present, should be used on the upper outer thigh
b. Bronchodilator should be sprayed in the middle of an inhalation PRN
9. Position patient properly, minimize movement, and try to keep the patient calm
a. If patient is in shock, place in shock position
b. If patient has SOB but no signs of shock, place in Fowler’s position
c. If bite/sting/injection, lower below level of the heart
Verbal Assessment
1. Perform a SAMPLE exam
a. Inquire about allergies and whether the patient has been exposed to the allergen
b. Inquire about past experiences with this allergen
c. Inquire about an epi-pen
Dos and Don’ts
 Do minimize patient movement
 Do reassess vital signs every 5 minutes
 Do write a run report
 Do remove the allergen from patient if possible and non-invasive (brush off dust, flush off any liquids,
etc.)
 Don’t give the patient anything by the mouth (food or liquids)
3
EMSC Medical Guidelines
Revised August 2014
Altered Level of Consciousness
Treatment, Physical Exam, and Transport:
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
4. Position properly and consider C-Spine
a. Left lateral to protect airway if C-spine is deemed unnecessary
b. Consider C-spine if reason for the ALOC is unclear or traumatic
5. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
6. Visualize and palpate the head
a. Note any DCAPBTLS and note the location
b. Look for Battle Signs, raccoon eyes, CSF from the nose or ears,
c. If shock is suspected, place patient in shock position
d. If trauma suspected, place in C-Spine
7. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
9. Determine and treat the mechanism of ALOC if possible
Verbal Assessment:
1. Perform SAMPLE exam (with friend/family if necessary)
a. If performing SAMPLE with patient, be wary of responses
2. Perform PQRST exam PRN
a. If performing PQRST with patient, be wary of responses
Dos and Don’ts
 Do anticipate vomiting
 Do reassess vital signs every 5 minutes
 Do write a run report
 Don’t give the patient anything by the mouth (food or liquids)
4
EMSC Medical Guidelines
Revised August 2014
Behavioral Emergencies
Treatment, Physical Exam, and Transport
1. Request DPS/LAPD backup
2. Determine patients level of responsiveness using AVPU
3. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
4. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
5. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
6. Make contact with someone who has knowledge of the patients history before making contact with
patient if possible
7. Attempt to take vital signs
8. Use restraints only if necessary to protect self, partner, or public from the patient
a. Never restrain the patient prone
b. 4 rescuers works well for restraining patients
c. Apply restraints to wrists and ankles (with a sheet across the midsection PRN)
Verbal Assessment
 Always maintain conversation with the patient
 Attempt to perform a SAMPLE exam
 If the patient is under conservatorship or 72-hour hold, and should the patient refuse transport, advise the
patient that the doctor or police officer has made the final decision to transport. It is now the patient's
decision to go quietly, without restraints, or force you to "tie" him/her down to the gurney and transport
against his/her will.
o Note: Many times, given this decision, the patient will decide to be transported quietly, without
force. A police officer must accompany all restrained patients and should at the minimum follow
all EMS 5150 transports.
Dos and Don’ts
 Do be vigilant at all times of changing behavior patterns in the patient
 Do document everything as thoroughly as possible
 Do request DPS/LAPD assistance if situation could be deemed unsafe
 Don’t do anything to aggravate the patient
 Don’t place yourself, your partner, or the public in any danger
Additional Notes
 Approach will vary based on the circumstances of the call and the patient
 NEVER put yourself in danger
 Secondary assessment can be waived if it could aggravate the patient
 Document as thoroughly as possible
5
EMSC Medical Guidelines
Revised August 2014
Burns
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Assess lung sounds and note volume and any irregularities
c. If singed nasal hairs, facial burns, or soot around mouth, consider ventilation
d. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Treat the burn(s) itself
a. Remove constrictive clothing or jewelry
b. Flush burns initially with saline to stop the burning
c. Estimate size of burn using rule of nines or rule of palm
d. Place burn dressings over burn, and then cover with dry, sterile gauze
e. If dry chemical burn, brush off and then flush with lots of water/saline
f. If liquid chemical burn, flush with lots of water/saline
6. Treat any complications from the burns
a. If electrical burn, consider possible cardiac arrhythmia
b. If explosion, look for associated traumatic injuries
7. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
d. All electrical burns should be transported
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine circumstances surrounding the burn to treat the burn properly
3. Determine if any treatment was instituted prior to EMS arrival
Dos and Don’ts
 Do stop the burning by flushing it with saline
 Do write a run report
 Do seriously consider transporting every patient
 Do monitor respiratory status vigilantly
 Don’t break blisters, remove tar, apply ice water/tape/ointment, or remove stuck clothing
6
EMSC Medical Guidelines
Revised August 2014
Cardiac Arrest
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. If unresponsive to verbal and painful stimuli, check for a carotid pulse
3. If carotid pulse not present, begin compressions immediately @ rate of >100 per minute
4. Have partner apply Automated External Defibrillator (AED) while compressions are being
performed
5. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS assistance
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
6. Follow the prompts from the AED
7. If shock is administered, begin a new round of CPR immediately, following the AHA compression
to breath ratio
8. Ventilate using a BVM with high flow, 100% oxygen using 2-person ventilating techniques
a. Use an OPA/NPA, unless contraindicated
b. Use suctioning PRN
9. Control bleeding PRN
10. Continue CPR until spontaneous restoration of pulse
In event of spontaneous restoration of pulse
1. Assess for spontaneous respirations
a. If no spontaneous respirations, ventilate @ AHA ratios for rescue breathing
b. If spontaneous respirations present, administer high flow oxygen
2. Place patient in shock position
3. Obtain a set of vitals and reassess every 5 minutes
Verbal Assessment
 Determine events preceding cardiac arrest
 Determine how long the patient has been down
 Determine if CPR was instituted prior to arrival
 Determine if DNR is present
 Determine medical history (if possible)
Dos and Don’ts
 Do perform CPR as long as necessary to have spontaneous restoration of pulse or until reaching the
nearest emergency paramedic receiving facility
 Do expedite transport
7
EMSC Medical Guidelines
Revised August 2014
Chest Pain
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Apply high flow oxygen if patient is experiencing SOB
c. Obtain lung sounds and note volume and any irregularities
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Visualize and palpate the chest
a. Note any DCAPBTLS
b. Look for JVD and pedal edema
c. Be specific when determining whether pain is cardiac, pleuritic, or muscular
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
8. Assist in administration of nitroglycerin if patient has nitro and meets indications
a. 5-BASH for contraindications
Verbal Assessment
1. Perform SAMPLE exam
2. Perform PQRST exam
a. Note differences between angina pectoris and acute MI
3. Ask if patient has taken any medications (aspirin/nitro) for this episode of chest pain
Dos and Don’ts
 Do administer oxygen PRN
 Do anticipate vomiting
 Do expedite transport
 Do write a run report
 Don’t scare the patient
8
EMSC Medical Guidelines
Revised August 2014
Chest Trauma
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
5. Visualize and palpate the entire thoracic area
a. Determine if there are any penetrating objects and stabilize accordingly if present
b. If major blunt injury mechanism suspected, consider C-Spine
c. If paradoxical movement present, taped large bulky dressing across flail chest
d. If subcutaneous emphysema, tracheal deviation, and/or JVD, consider tension pneumothorax
e. If sucking chest wound present, tape occlusive dressing on three sides and release pressure as
necessary based on presence of lung sounds
f. If pulse pressure is very low, consider cardiac tamponade
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
8. Perform rapid and detailed trauma assessments
a. Look for DCAPBTLS
Verbal Assessment
1. Determine injury mechanism
2. Perform SAMPLE exam
Dos and Don’ts
 Do reassess vitals every 5 minutes
 Don’t give the patient anything by mouth
9
EMSC Medical Guidelines
Revised August 2014
Cold Injuries
Treatment, Physical Exam, and Transport
1. Remove patient from cold environment
2. Determine patients level of responsiveness using AVPU
3. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
4. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
5. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
6. Remove wet clothing and jewelry and begin passive warming measures (blankets and heating the
ambulance)
a. Once warming measures have been started, do not allow the patient to become cold again
7. Visualize any areas with potential frostbite and cover with dry dressing (do not touch them)
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine the type and temperature of environment
3. Determine length of time that the patient was in the cold environment
4. Determine amount of area affected by cold temperatures
5. Determine if any treatment was instituted prior to EMS arrival
Dos and Don’ts
 Do remove the patient from the cold environment
 Do use CPR if necessary
 Don’t touch frostbitten or blistered areas except to place a dry, sterile dressing on them
 Don’t allow patient to cool down after beginning warming measures
10
EMSC Medical Guidelines
Revised August 2014
Diabetic Emergencies
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
c. Be prepared to ventilate PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. If patient presents ALOC, assess for potential causes of ALOC other than diabetic emergency
with a rapid trauma assessment
6. If sufficient information present to assume diabetic emergency, administer oral glucose, even if the
patient is unconscious, but not if signs of CVA exist
7. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam and record the findings
2. If patient presents ALOC, question bystanders/witnesses/friends/family about patient’s behavior
3. Check for Medical Alert tags or insulin pumps
4. Determine how patient controls his/her diabetes and determine compliance with method of control
Dos and Don’ts
 Do reassess patient’s mental status after administering oral glucose
 Do administer oral glucose regardless of if you think it is hyper- or hypoglycemia unless a higher
medical authority specifically says not to administer it
 Do anticipate vomiting and have suction ready
 Don’t lay the patient supine
 Don’t forget SAMPLE
11
EMSC Medical Guidelines
Revised August 2014
DO NOT RESUSCITATE ORDERS (DNR)
Definitions (for the purpose of this policy only the following definitions will be prescribed:)
 Resuscitation - Interventions, whose purpose is to restore cardiac activity and respirations including
CPR, defibrillation, advanced airway management, and the use of cardiotonic drugs.
 Supportive measures - Any medical intervention used to provide for the relief, comfort, safety, or for
the dignity of the patient.
 Valid DNR orders o DNR orders written in the patient’s chart which state “no CPR,” “DNR,” “Do Not Resuscitate,”
etc. at a licensed medical facility (nursing home, hospital, hospice)
OR
o Verbal orders given in person by an M.D., “not to resuscitate the patient.” This must be followed
by an immediate written order which should include the physician’s California medical license
number.
OR
o A patient found in the home or elsewhere with fully executed Prehospital DNR Form #815.1,
#815.2, or State approved DNR medallion (Policy #815) when the patient can be absolutely
identified by a friend, relative, witness, or by picture I.D. The patient’s lawful surrogate does not
need to be present at the scene to honor the DNR order. The DNR form must be present and
completed in order for EMTs to withhold resuscitation.
o Note: Valid orders shall not include (for the purpose of this policy) “Durable Power of
Attorney,” “Living Wills,” out of County DNR orders, DNR identification, or DNR orders which
are not considered valid by Los Angeles County EMS Policy 815.1.
Directives
 When EMTs respond to a terminal event where there are valid DNR orders they shall identify the patient
and manage the patient in accordance with the wishes of the patient and that patient’s family.
 Unless a conflict results with the patient or patient’s family, EMTs will withhold resuscitation in a
patient having valid DNR orders.
 Living patients will always be provided with supportive measures which will include, but not be limited
to the administration of oxygen, basic airway maintenance (no EOA/ET), control of bleeding, treatment
of shock, and immobilization of injuries. EMTs will provide for the patient’s comfort, safety, and
dignity whenever possible.
 If there is any objection or disagreement by the patient’s family or the patient’s caretaker about
withholding resuscitation or if prehospital personnel have any reservations regarding the validity of a
DNR order, resuscitation should begin immediately.
 Activate DPS Emergency and contact LAFD/the proper EMS agency only if transport is necessary or if
the patient is deceased with a valid DNR order
o Call (213) 740 – 4321
o Request ALS/BLS or explain that the patient is deceased with a valid DNR
o Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Documentation
1. Check the “DNR” box in the Emergency Medical Services (EMS) report
2. Describe any and all treatment provided
3. Print the physician’s name and the date the DNR form or order was signed under “comments” in the
EMS Report. Retain the provider (NCR) copy of the 815.1 form if applicable and available
12
EMSC Medical Guidelines
Revised August 2014
Eye Injuries
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
5. Visualize the injured eye
a. If injury is penetrating injury, secure object in place with gauze, cups, or anything else necessary
to secure it; transport in Fowler’s position
b. If injury is due to chemical substance, flush from medial to lateral eye with saline for the
duration of the transportbeing careful not to get liquid in other eye
c. If injury is due to small foreign object, attempt to flush the object out with saline
d. If suspected orbital (blow-out) fracture, cover the injured eye and transport ASAP
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Inquire about injury mechanism
2. Perform SAMPLE exam
3. Perform PQRST exam PRN
4. Determine if patient has blurred or obstructed vision
Dos and Don’ts
 Do determine the mechanism of injury
 Don’t remove penetrating objects in the eye
13
EMSC Medical Guidelines
Revised August 2014
Foreign Body Airway Obstruction
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Determine airway patency and presence of a foreign body obstructing the airway
a. If the patient is conscious, and able to talk, cough or exchange air:
i.
Reassure the patient
ii.
Encourage the patient to cough
iii. Administer high flow oxygen as tolerated
iv.
Do not perform abdominal thrusts / Heimlich
b. If the patient is conscious, but unable to talk or cough:
i.
Administer a series of five abdominal thrusts / Heimlich. (If the patient is pregnant or
too obese to accommodate effective abdominal thrusts, apply chest thrusts instead.)
ii.
Reassess the patient's ability to speak or cough
iii. Continue abdominal thrusts until the obstruction is relieved or the patient becomes
unconscious
iv.
Have suction ready for use.
c. If the patient is unconscious when found, or loses consciousness:
i.
Open the patient's airway and attempt to ventilate.
ii.
If this is unsuccessful, reposition the patient's head and attempt to ventilate again.
iii. If this is still unsuccessful, administer 30 chest compressions. Look in the patient’s
mouth and remove any visible foreign matter with a finger sweep. DO NOT perform
blind finger sweeps.
iv.
Reattempt to ventilate the patient.
v.
Continue with CPR (checking the mouth for the obstruction after each set of
compressions) until the obstruction is relieved, but do not delay transport.
vi.
Monitor pulse.
d. If the patient is an infant (< 1 year) and conscious, apply back blows (5) and chest thrusts (5)
instead of abdominal thrusts, with the infant’s head below the legs, until the obstruction is
relieved or the patient becomes unconscious. Do not attempt finger sweep.
e. If the infant patient is unconscious, perform infant CPR, checking the mouth for obstruction after
each set of compressions. If an obstruction is visible, remove it, being careful not to push it
further into the pharynx. DO NOT perform blind finger sweeps.
f. If the patient is a child (18 months or older), treat as an adult using the appropriate force. Do not
perform blind finger sweeps.
3. If the obstruction is not relieved:
a. Continue efforts to relieve the obstruction.
b. Expedite transport.
c. Administer ventilation with 100% oxygen using a bag-valve-mask between attempts to relieve
obstruction.
d. Anticipate the patient vomiting and have suction ready.
4. If the obstruction is relieved:
a. Place the patient in high fowlers.
b. Administer high flow oxygen.
c. Continually reassess the patient’s airway and lung sounds.
5. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
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EMSC Medical Guidelines
Revised August 2014
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
Verbal Assessment (only performed after airway obstruction is relieved)
1. Perform a SAMPLE exam
2. Inquire about injury mechanism
Dos and Don’ts
 Do try to encourage coughing as much as possible
 Do expedite transport in cases that the airway obstruction is not dislodged
 Do have suction standing by
 Don’t perform blind finger sweeps on anyone
 Don’t perform abdominal thrusts to any pregnant women or person too obese for them to be effective
 Don’t forget infant CPR regulations
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EMSC Medical Guidelines
Revised August 2014
Head and Neck Trauma
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Apply C-Spine precautions
4. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
5. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
6. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
7. Visualize and palpate the entire head and neck area, noting DCAPBTLS and instability
a. Determine if there are any penetrating objects and stabilize accordingly if present
b. If penetrating neck wound present, tape occlusive dressing down on all four sides
c. If signs of intracranial pressure present (Cushing’s Triad, CSF leakage, irregular pupils), place
patient in Reverse Trendelenberg’s position
d. Check for gray matter exposure and, if present, treat it as an evisceration
e. Check for PMS in all extremities
f. If bleeding wound lies over suspected skull fracture, apply gentle pressure and cover loosely
g. Apply a cold pack to any contusion or hematoma
h. Do not restrict fluid flow from ears, nose, or mouth
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Consider other conditions which may mimic neurological trauma, such as alcohol or drug
ingestion, seizures and post-ictal states, diabetes, or CVA
10. Perform rapid and detailed trauma assessments
a. Look for DCAPBTLS
Verbal Assessment
1. Determine injury mechanism
2. Inquire about any loss of consciousness and the length of it
3. Perform SAMPLE exam
Dos and Don’ts
 Do anticipate vomiting
 Don’t delay transport in the field, assess in the back of the rig if necessary to expedite transport
 Don’t give the patient anything by mouth
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EMSC Medical Guidelines
Revised August 2014
Heat Exposure
Treatment, Physical Exam, and Transport
1. Remove patient from hot environment
2. Determine patients level of responsiveness using AVPU
3. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
4. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
5. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Important to assess skin signs (paying particular attention to fontanels in peds)
6. Remove patient’s clothing in the ambulance/cool place
7. Begin cooling measures based on the symptoms presented by the patient
a. If patient is sweating (indicates heat exhaustion), cool gradually by fanning or sponging with
lukewarm water; if conscious and alert, administer small sips of water
b. If patient is not sweating, potentially altered, and has hot skin (indicates heat stroke), cool by
fanning or sponging with lukewarm water and placing cold packs in the armpits, behind the
neck, and in the groin; monitor closely for rebound hypothermia
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine the type and temperature of environment
3. Determine length of time that the patient was in the hot environment
4. Determine if any treatment was instituted prior to EMS arrival
5. Determine whether patient had any seizures
6. Determine patient’s fluid intake/output
Dos and Don’ts
 Do anticipate ALOC, combative behavior, and vomiting
 Do pay attention to what type of heat injury the patient is experiencing
 Do expedite transport if heat stroke expected
 Don’t give the patient too much water
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EMSC Medical Guidelines
Revised August 2014
Ingestion/Poisoning
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
c. Have suction ready and anticipate vomiting
d. Check for oropharyngeal burns
3. Determine pulse oximetry and assess breathing
a. Administer oxygen based on the patient’s respiratory status
b. Assess lung sounds and note volume and any irregularities
c. Consider ventilation based on breathing rate and rhythm
d. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Determine the substance if possible and treat any potential complications from ingestion/poisoning
a. Assess the patient’s breath for odor of alcohol, acetone, hydrocarbons, or any other notable odor
b. If chemical exposure, attempt to obtain SDS for the emergency department
c. If skin was exposed to something, brush off dry material and flush burns
d. Collect any syringes or containers that might have been used as long as it is safe for EMS
personnel to do so
e. If agent was a stimulant (such as PCP), limit disturbing stimuli and consider DPS response
f. Position according to LOC and respiratory status
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine what was ingested and how much
3. Determine whether it was a suicide attempt
4. Determine whether the patient has vomited or not
Dos and Don’ts
 Do anticipate ALOC, combative behavior, and vomiting
 Do pay attention to environmental dangers (ex. don’t enter a crystal meth lab, etc.)
 Do expedite transport if respiratory status or LOC deteriorates rapidly
 Don’t give the patient anything by mouth
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EMSC Medical Guidelines
Revised August 2014
Multi-Casualty Incidents
1. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location and general description of the MCI
2. Call for and anticipate any additional resources.
3. Relevant Assessment Information and Physical Findings.
a. Make sure the environment is safe before entering.
b. Survey the scene to determine the extent and magnitude of the incident and to find out where the
most critical patients are located.
4. Triage and treat the patients
a. Note: Remember “The 5 T’s” of MCI management: Tag, Triage, Transfer, Treat,
Transport
b. Call for the walking wounded to come to your voice
c. Set up an area for minor ambulatory patients to gather
d. Apply MCI tags to each patient found
e. Use the START Plan as your triage tool to determine the number and severity of victims marking
the tags accordingly
f. Physically group patients by severity if possible
g. When ALS arrives, give them a size-up report
h. Treat victims as the ALS team requests. Take directions from the paramedics
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EMSC Medical Guidelines
Revised August 2014
Multi-System Trauma
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. Use suction PRN
c. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Administer high flow oxygen
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
b. Estimate blood loss
5. Apply C-Spine precautions
6. Perform rapid and detailed trauma assessments and treat injuries as you find them (ex. occlusive
dressing over a sucking chest wound)
a. Look for DCAPBTLS
7. Position according to symptoms exhibited by the patient (ex. if not hypotensive with a head injury,
place in Reverse Trendelenberg’s position)
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine mechanism of injury
Dos and Don’ts
 Do reassess vitals every 5 minutes
 Don’t give anything by mouth
 Don’t delay transport for anything
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EMSC Medical Guidelines
Revised August 2014
Near Drowning
Treatment, Physical Exam, and Transport
1. Remove patient from water
2. Determine patients level of responsiveness using AVPU
3. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
4. Determine pulse oximetry and assess breathing
a. Administer high flow oxygen
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
5. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
6. Treat any possible conditions causing the accident or resulting from the accident
a. Consider C-Spine if head, neck, or back trauma suspected
b. Control bleeding
c. Treat any other associated injuries as outlined in these medical guidelines
7. Position according to symptoms exhibited by the patient (ex. if not hypotensive with a head injury,
place in Reverse Trendelenberg’s position)
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine how long the patient was in the water
3. Determine the temperature and type (salt, fresh, etc.) of water that the patient was in
4. Ask about any other potential underlying causes of the accident
5. Determine whether the patient had been scuba diving
6. Determine whether the patient has vomited
Dos and Don’ts
 Do encourage the patient to seek treatment due to possibility of delayed complicated
 Do have patient sign AMA paperwork if patient refuses transport
 Do anticipate vomiting
 Do utilize DPS as a resource if parent(s) endangers the life of a child by refusing transport
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EMSC Medical Guidelines
Revised August 2014
Obstetrical Emergencies
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. If delivery is imminent:
a. Place mother in position of comfort with hips elevated and legs spread
b. Clean labia with wipes in OB kit
c. Apply sterile gloves
d. Place one hand over vaginal opening to prevent explosive delivery
e. Check for nuchal cord as baby’s head and neck present
f. Suction and stimulate chest and back to induce spontaneous respirations in the infant PRN
g. Clamp cord 6 inches and 8 inches away from baby and cut between the clamps
h. Swaddle the baby
i. Assess infant using APGAR at 1 and 5 minutes
j. Encourage breast feeding from the mother
k. Allow placenta to deliver normally, but do not wait at the scene for the placenta to deliver
l. Massage fundus after placental delivery
m. Be alert to possibility of multiple births
4. Be wary of these complications and expedite transport if any of these present:
a. If delivery involves breech presentation, elevate mother’s hips, insert gloved hand into vagina,
and create an airway for the infant
b. If umbilical cord is wrapped around infant’s neck, attempt to slip it up and over the infant’s head;
if not possible, clamp the cord and cut
c. If cord is prolapsed:
i. Place mother in left lateral with hips elevated
ii. Administer high flow oxygen
iii. If cord becomes pulseless, insert gloved hand into vagina and gently push until the cord
can become properly perfused again
d. If mother becomes toxemic or starts actively seizing, reduce disturbing stimuli
e. Before delivery, regardless of trimester of pregnancy, if patient is vaginally hemorrhaging:
i. Administer high flow oxygen
ii. Control the patients bleeding with OB pads
iii. Keep patient warm
iv. Place patient in shock position
v. Expedite transport in this position
5. If, during initial or reassessment, the infant’s condition deteriorates:
a. Perform neonatal CPR at rate of 3:1 compressions to ventilations if heart rate is below 60 bpm
b. Ventilate with an infant-sized BVM if heart rate is below 100 bpm
6. Continually reassess both patients
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine how many previous pregnancies (gravida) and how many live births (para)
3. Determine length of time between contractions
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EMSC Medical Guidelines
4. Determine if the water is broken
5. Determine if there is any prior history of obstetrical problems
6. Determine due date, prenatal care, medications, and possibility of twins
Revised August 2014
Dos and Don’ts
 Do continually reassess both patients after birth
 Do be wary of any and all complications associated with birth
 Don’t drive while the mother is delivering
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EMSC Medical Guidelines
Revised August 2014
Orthopedic Injuries
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
5. Visualize and palpate the area of orthopedic concern
a. Remove or cut the patient’s clothing
b. If patient presents with fracture:
i. Determine if it is open or closed
ii. If open, place sterile dressing with saline over fracture site and splint
iii. If closed, splint in position found
c. If patient presents with dislocation:
i. Do not realign, only splint on position found
d. If patient presents with amputation:
i. Pack the wounded area with dry sterile gauze
ii. Place cold packs over area
iii. Apply tourniquet immediately proximal to the amputation (and apply another tourniquet
directly proximal to the original tournique PRN to control bleeding)
iv. Retrieve amputated portion, wrap in dry sterile gauze, place in plastic bag, surround with
cold packs, and bring to emergency department
e. If patient presents with mid-shaft, isolated femur fracture:
i. Use traction splint
ii. Pull traction equal to 1/10 of the patient’s body weight
iii. Immobilize leg on backboard
f. When splinting hands/feet, leave fingers and toes exposed to evaluate for presence of PMS
g. If nerve/pulse deficit exists after splinting, loosen or remove the splint
h. Splint must extend past 2 nearest proximal and distal joints to the injury
i. Always splint in position found
j. Never tape or strap over an injury or an uninjured joint
6. Apply C-Spine precautions PRN
7. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
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EMSC Medical Guidelines
Verbal Assessment
1. Perform SAMPLE exam
2. Determine mechanism of injury
3. Compare to opposite extremity
Revised August 2014
Dos and Don’ts
 Do follow the four rules of splinting (underlined in section 5 above)
 Do attempt to keep the patient calm and in a position of comfort
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EMSC Medical Guidelines
Revised August 2014
Poisonous Bites and Stings
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Assess lung sounds and note volume and any irregularities
c. Consider ventilation PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Treat the bite/sting itself
a. If patient presents with jellyfish sting:
i. Rinse wound with alcohol or salt water (no fresh water)
ii. Do not rub or apply pressure to wound
iii. Inactivate cysts with baking soda, vinegar (preferred), household ammonia, or meat
tenderizer
b. If patient presents with a bee sting:
i. Scrape stinger off skin
ii. Apply cold packs
c. If patient presents with a snake bite:
i. Splint extremity and keep it below the level of the heart (do not apply cold pack or bands)
ii. Circle bite and note the time of the bite
d. If patient presents with spider bite:
i. Clean area with saline and apply dressing
ii. Restrict movement, keep heart rate down, and keep extremity below level of heart
6. Treat any complications from the bite/sting
a. Look for possible anaphylactic symptoms
b. Expedite transport if patient’s status deteriorates
7. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
d. All electrical burns should be transported
Verbal Assessment
1. Perform a SAMPLE Exam
2. Determine the causative agent and, if possible, acquire it to bring to the emergency department
3. Inquire about any possible anaphylactic symptoms
4. Determine if there are any lacerations, sting marks, welts, or hives
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EMSC Medical Guidelines
Dos and Don’ts
 Do keep the patient as calm as possible and minimize activity
 Do expedite transport if patient’s status deteriorates
 Do bring the causative agent if not dangerous for EMS personnel to acquire
 Don’t elevate the extremity above the heart
Revised August 2014
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EMSC Medical Guidelines
Revised August 2014
Respiratory Emergencies
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Apply oxygen according to the patients respiratory status
c. Obtain lung sounds and note volume and any irregularities
d. Consider ventilation PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Treat the shortness of breath
a. If hyperventilation is suspected and if the patient has tingling around the mouth or extremities, a
history of recent emotional upset, and you have checked for cyanosis and ruled out any other
causes:
i. Eliminate or decrease negative environmental stimuli
ii. Administer low flow oxygen through nasal cannula
6. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
7. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
8. Assist in administration of a bronchodilator if patient has one
a. Bronchodilator should be sprayed in the middle of an inhalation PRN
Verbal Assessment
1. Perform a SAMPLE exam (pay attention to history of chronic pulmonary or cardiac disease)
2. Perform an OPQRST exam
3. Establish if this is an acute or chronic condition
4. Inquire about pedal edema, JVD or accessory muscle usage
Dos and Don’ts
 Do give the patient oxygen
 Do place the patient in high Fowler’s position
 Do minimize the patient’s activity
 Do identify the causative agent if possible
 Do expedite transport if patient is in acute respiratory distress
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EMSC Medical Guidelines
Revised August 2014
Seizure
Treatment, Physical Exam, and Transport
NOTE: If the patient is actively seizing:
 Protect the patients airway by positioning and not allowing foreign bodies into the airway
 Administer blow-by oxygen at 25 LPM
 Protect the patient from trauma by clearing the immediate area of anything that could hurt the patient
 Activate DPS emergency and request ALS
Post-Seizure:
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Obtain lung sounds and note volume and any irregularities
c. Consider ventilation PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Complete a rapid and detailed physical exam
a. Look for DCAPBTLS
b. Treat any associated injuries
6. If found status post-epilepticus, rule out other causes of ALOC
7. Consider C-Spine precautions if major traumatic injury is suspected post-seizing
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
9. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
Verbal Assessment
1. Attempt to reorient the patient before performing verbal assessment
2. Perform SAMPLE exam
3. Question bystanders about:
a. What the seizure looked like
b. How many seizures were observed
4. Determine whether patient is compliant with medications
Dos and Don’ts
 Do attempt to reorient the patient
 Do activate ALS if the patient is unconscious and unresponsive
 Do ask about a history of epilepsy
 Do consider other causes of ALOC and look for track marks
 Do anticipate vomiting and have suction ready
29
EMSC Medical Guidelines
Revised August 2014
Sexual Assault
NOTE: ENSURE THAT A POLICE UNIT IS RESPONDING TO THE INCIDENT
Treatment, Physical Exam, and Transport
1. Do not remove the patients clothes unless life-saving intervention is required and touch the patient
as little as possible
2. Determine patients level of responsiveness using AVPU
3. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
4. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Obtain lung sounds and note volume and any irregularities
5. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
6. Provide reassurance and emotional support
7. Encourage the victim to be transported
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
10. Assist in administration of a bronchodilator if patient has one
a. Bronchodilator should be sprayed in the middle of an inhalation PRN
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine if the patient washed, bathed, or changed clothes (obtain dirty clothes if possible)
3. Determine if there are any associated injuries
4. Determine where the incident occurred and do not disturb crime scene
5. If assault just occurred, get description and direction of travel for the officers
Dos and Don’ts
 Do keep the patient as calm as possible and provide emotional support
 Do place the patient in a position of comfort
 Don’t disturb the crime scene unless life-saving intervention is required
30
EMSC Medical Guidelines
Revised August 2014
Shock
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift (or modified jaw-thrust depending on injury
mechanism)
b. Use suction PRN
c. Use ventilation PRN
d. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Administer high flow oxygen
b. Assess lung sounds and note volume and any irregularities
c. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding (control bleeding if present)
b. Estimate blood loss
5. Perform rapid and detailed trauma assessments and treat injuries as you find them (ex. occlusive
dressing over a sucking chest wound)
a. Look for DCAPBTLS
b. Look for evidence of internal bleeding (bloody stools, coffee ground emesis, vaginal bleeding,
rigid abdomen, etc.)
6. Place in shock position and keep patient warm
7. Apply C-Spine precautions
8. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
9. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine if LOC has been constant throughout the incident
3. Determine whether person has had diarrhea or bloody stools
4. Determine mechanism of injury
5. Determine whether patient has vomited or feels nauseous
Dos and Don’ts
 Do reassess vitals every 5 minutes
 Don’t give anything by mouth
 Don’t delay transport for anything
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EMSC Medical Guidelines
Revised August 2014
Stroke
Treatment, Physical Exam, and Transport
1. Determine patients level of responsiveness using AVPU
2. Ensure airway patency
a. If airway not patent, perform head-tilt-chin-lift
b. To ensure patency after opening the airway, consider use of OPA or NPA if indications are met
3. Determine pulse oximetry and assess breathing
a. Use nasal cannula at 6 LPM if patient’s oxygen saturation is below 94%
b. Administer high flow oxygen
c. Consider ventilation PRN
d. Utilize other breathing devices PRN
4. Check circulation through capillary refill and ensure proper perfusion through checking for a
radial pulse
a. Check skin signs and look for obvious bleeding
5. Perform a stroke assessment using the Cincinnati Stroke Scale
a. Note any facial droop by asking patient to smile
b. Note any bilateral or one-sided weakness by testing the patient’s grip
c. Note any slurred speech through asking them to repeat “The sky is blue in Cincinnati”
6. Position patient in high Fowler’s if conscious and left lateral combined with reverse
Trendelenberg’s position if unconscious
7. Take vital signs
a. Blood pressure, eyes, lung sounds, level of consciousness (Glasglow AND A&O), skin signs,
respirations, pulse
8. Activate DPS Emergency and contact LAFD/the proper EMS agency
a. Call (213) 740 – 4321
b. Request ALS/BLS PRN
c. Provide exact location, age, sex, chief complaint, LOC, whether vitals are stable or not, any
special information relevant to patient care
Verbal Assessment
1. Perform a SAMPLE exam
2. Determine baseline mental status
3. Determine time of onset for symptoms (extremely important)
4. Question bystanders/witnesses for clues to patient’s condition if necessary
5. Determine if there have been any previous occurrences/prior deficits
6. Determine if patient had a headache prior to onset of symptoms
Dos and Don’ts
 Do anticipate vomiting
 Do perform a stroke assessment
 Don’t forget to establish baseline mental status and time of onset for the symptoms
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